Wednesday, October 15, 2008

Worries about money can take a toll on your teeth

Does the sinking stock market cause you to clench your teeth?

Do you wake up with a headache, sore teeth or a sore jaw? Millions of people clench and grind their teeth without realizing it, particularly while they're sleeping. Both habits can escalate into serious pain and problems of the temporomandibular joint, or TMJ, which joins the jaw to the skull. And they are far more common at times of stress.

"TMJ and Wall Street go hand in hand, especially lately," says Anthony Chillura, a longtime dentist in New York City's financial district. "Some people get ulcers. Some people get high blood pressure. Some manifest their stress dentally."

While most people clench or grind their teeth (a condition known as bruxism) from time to time, about 10 percent suffer from TMJ problems - and those can set in suddenly. TMJ disorder can mimic migraine headaches, earaches, sinus infections and tooth abscesses. It can cause dizziness, ringing in the ears and muscle pain that radiates down the neck and shoulders.

In some people, the real culprit is a misaligned bite - either from birth or a trauma like a fall or a collision in sports. "It's like you're chewing with a limp," says Harold Gelb, an oral orthopedist in Manhattan who says problems can be building for years and flare up under stress.

Other people "brux" only when they're under stress, especially at times of change like a divorce or financial crisis, says Andrew S. Kaplan, another Manhattan TMJ expert and former president of the American Academy of Orofacial Pain.

Much of the tension comes out at night, when higher centers of the brain are asleep, says Noshir Mehta, director of the Craniofacial Pain Center at Tufts University School of Dental Medicine.

A clenched jaw can exert up to 300 pounds of pressure, which can wear teeth down and crack them, particularly where there are cavities or old fillings. Over time, arthritis, inflammation and degenerative changes can occur in the jaw joint. The disc in the joint can shift and make clicking or popping sounds. It can also "lock" out of place, making it impossible to open the mouth more than an inch or so.

All that tension also strains the big jaw muscles and activates irritable knots called myofascial trigger points, which produce still more tension and refer pain to other muscles.

Women have more TMJ problems than men - possibly because the jaw muscle bulks up in men, whereas it becomes dysfunctional in women, says Mehta. People taking antidepressants are also more prone to bruxing, for reasons not well understood.

The most common treatment for TMJ is a night guard that fits between the teeth and makes grinding more difficult. Chillura also makes smaller appliances that permit talking for patients who can't stop clenching during the day. Custom-made appliances cost anywhere from $300 to $1,800. Devices that correct misaligned bites can cost $2,500. Over-the-counter mouthguards cost as little as $20 and are better than nothing, some dentists say.

Once TMJ problems have set in, anti-inflammatories or muscle relaxants can be helpful. Studies at Tufts have shown that magnesium citrate - 250 to 400 milligrams daily - can also help relieve muscle tension.

Read the rest on the Daily Herald Web Site

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